Multi-level determinants of failure to receive timely and complete measles vaccinations in Southwest China: a mixed methods study

Background Measles outbreaks re-emerged in 2013–2014 in Guangxi Zhuang Autonomous Region of China, where measles immunisation coverage is high. The discrepancy between the vaccination coverage and outbreaks indicates that timeliness is crucial, yet there is limited knowledge on the health system barriers to timely vaccination. Using integrated evidence at the household, village clinic, and township hospital levels, this study aimed to identify the determinants of failure in receiving timely measles vaccinations among children in rural Guangxi. Methods A multi-stage stratified cluster sampling survey with a nested qualitative study was conducted among children aged 18–54 months in Longan, Zhaoping, Wuxuan, and Longlin counties of Guangxi from June to August 2015. The status of timely vaccinations for the first dose of measles-containing vaccine (MCV1) and the second dose of measles-containing vaccine (MCV2) was verified via vaccination certificates. Data on household-level factors were collected using structured questionnaires, whereas data on village and township-level factors were obtained through in-depth interviews and focus group discussions. Determinants of untimely measles vaccinations were identified using multilevel logistic regression models. Results A total of 1216 target children at the household level, 120 villages, and 20 township hospitals were sampled. Children were more likely to have untimely vaccination when their primary guardian had poor vaccination knowledge [MCV1, odds ratio (OR) = 1.72; MCV2, OR = 1.51], had weak confidence in vaccines (MCV1, OR = 1.28–4.58; MCV2, OR = 1.42–3.12), had few practices towards vaccination (MCV1, OR = 12.5; MCV2, OR = 3.70), or had low satisfaction with vaccination service (MCV1, OR = 2.04; MCV2, OR = 2.08). This trend was also observed in children whose village doctor was not involved in routine vaccination service (MCV1, OR = 1.85; MCV2, OR = 2.11) or whose township hospital did not provide vaccination notices (MCV1, OR = 1.64; MCV2, OR = 2.05), vaccination appointment services (MCV1, OR = 2.96; MCV2, OR = 2.74), sufficient and uniformly distributed sessions for routine vaccination (MCV1, OR = 1.28; MCV2, OR = 1.17; MCV1, OR = 2.08), or vaccination service on local market days (MCV1, OR = 2.48). Conclusions Guardians with poor knowledge, weak beliefs, and little practice towards vaccination; non-involvement of village doctors in routine vaccinations; and inconvenient vaccination services in township hospitals may affect timely measles vaccinations among children in rural China. Graphical abstract

Single Server Queuing Model to Determine the Patient Flow Process in a Township Hospital

This research aims to analyse the use of queuing theory in the two branches of a local township health care centre located in a small township in Tamil Nadu, India. A scenario from the out-patient departments of the aforesaid centre shows the relationship between the different variables operating the system. The focus of this research is also to provide some insights for improving the efficiency of the medical centre through the queuing model. The research concludes that the Queuing system at branch A of the health centre is 93% efficient and at Branch B it is 73%efficient.

Delays in care seeking, diagnosis and treatment of patients with pulmonary tuberculosis in Hubei, China

Background Early diagnosis and treatment are essential for effective tuberculosis (TB) control. However, delays in the diagnosis and treatment of TB in central China have not been sufficiently investigated. This cross-sectional study was conducted between October 2013 and March 2014 in Hubei, China to identify risk factors of delays in care seeking, diagnosis and treatment among patients with TB. Methods A total of 1342 patients with TB seen in the designated institutions were included. Multivariate logistic regression was used to analyse factors associated with delays in TB diagnosis and treatment. Results Overall, 21.54%, 23.62% and 42.25% of patients with TB experienced delays in care seeking, diagnosis and treatment, respectively. Multivariate logistic regression showed that medical insurance and monthly household income were significantly associated with delays in care seeking. The time to reach a township hospital or the facility of a patient’s first consultation was significantly associated with delays in diagnosis. Sex, education, time to reach a township hospital and the facility where the diagnosis was made were significantly associated with delays in treatment. Conclusions Delays in TB diagnosis and treatment in Hubei remain a serious issue. Improvements in the capability and accessibility of health care services are imperative to reduce delays and expedite TB diagnosis and treatment.

Determinants of patient choice for hospital readmission after township hospitalisation: a population-based retrospective study in China

ObjectiveThe lack of coordinated and appropriate healthcare across sectors has produced more patients for county hospitals in China. This study examined differences in patient choice between township and county hospitals for readmission after a first township hospitalisation, and the determinants that influenced this choice.DesignA retrospective study of readmissions across hospitals after a first admission in township hospital. A township–township (TT) inpatient group and a township–county (TC) inpatient group were compared. A two-level logistic regression model was used to examine the determinants of choice for hospital readmission.SettingData were drawn from a population-based health utilisation database for Qianjiang District, China, from 1 January 2008 to 31 December 2013.ParticipantsThis study focused on readmitted patients whose first admission was in a township hospital. Readmission cases were identified as the same diagnosis (International Classification of Diseases, Tenth Revision) in a subsequent hospitalisation within 30 days. In total, 6764 readmissions had first admissions in township hospitals.Primary outcome measuresPatient choice for hospital readmission after a first township hospitalisation.ResultsThe TT group accounted for 62.5% (4225) and the TC group for 37.5% (2539) of readmissions in 6 years, and the proportion of TC readmissions in total inpatients increased from 1.66% to 1.89%. Readmission rates varied among towns (p<0.001). Differences between the TC and TT groups included: length of stay (LOS) of first admission (6.96 days vs 9.23 days), average interval between admissions (6.03 days vs 14.95 days) and disease category. Admission year, age, travel time to county hospital, interval between admissions, first admission LOS and disease category were determinants of choice for hospital readmission.ConclusionsPatients whose first admission was in a township hospital were more likely to be readmitted to a county hospital. A combination of first LOS and interval between admissions may be an effective identification index for TC readmission.Trial registration numberChiCTR-OOR-14005563.

Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital

Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results. About 75% (28/39) of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39) mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39) showed their satisfaction about the achievement of serving as a doctor. Conclusion. Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor’s relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.